I’m on 75mg of Levothyroxine and I’m on 2 different makes for 50mg MercuryPharma and 25mg Teva. Will this affect me?

[Kathy6]

After ready on here on other posts about how important sticking to the same make is, so I checked mine and found I was on 2 different makes. I change my pharmacy last June and I’m uncertain if this has been happening since I changed. I do no last months were the same. My symptoms have been gradually getting worse and my anxiety is bad. I’ve just had my blood tests done and have asked the Pharmacy to make sure my medication is the same make and have order a new prescription for the 25mg so they match. I may clutching at straws here, but can someone answer this question for me. Thank you

[helvella Administrator Thyroid UK]

Two different makes alongside each other isn't, in itself, a problem.

I have been taking two different makes for years. But I am very careful that one make is always the same (Accord), and the other is one of a few possibilities.

If you were doing well on, say, A + B, fine. Carry on.

If you are not, as you say, you have the problem of deciding what to do. Remember that 25 microgram tablets are simply not available in all makes. For example, Accord only make 50 and 100 microgram tablets. And Wockhardt only make 25 microgram tablets. You might have to split 50 microgram tablets. Which might mean you prescription needs to be re-written.

Getting both in one make is a useful step but might not be the answer. You could find yourself going through several changes until you find what works best for you.

If you are getting Northstar or Almus - look on the card outer, or the Patient Information Leaflet. You will see that 50 and 100 microgram tablets are made by Accord. And Northstar 25 microgram tablets are made by Teva.

The dosing of thyroid hormones is usually in micrograms (mcg) - not milligrams (mg).

But the dosing of desiccated thyroid is usually milligrams (mg) or grains.

The document linked below says it all, I hope:

dropbox.com/s/q00vyt5703f4u...

[SlowDragon Administrator]

Teva brand upsets many, many people

Ask for new prescription for 25mcg and make sure to get Mercury Pharma brand

Ask pharmacy before they dispense it if they have Mercury Pharma....if not, take prescription elsewhere

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap. Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[SlowDragon Administrator]

How long have you been on just 75mcg levothyroxine

This is only one step up from starter dose, some symptoms may be due to being under medicated

What vitamin supplements are you currently taking

When were vitamin D, folate, ferritin and B12 last tested

Recommend Getting FULL thyroid and vitamin testing 6 weeks after getting back on just Mercury Pharma brand at 75mcg

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[SlowDragon Administrator]

Anxiety is common hypothyroid symptom

Looking at previous posts you have been left on this dose long time?

Presumably you have Hashimoto’s (autoimmune thyroid disease)

Having Crohns disease as well you are likely to have very low vitamin levels unless taking significant supplements

[Kathy6]

I really appreciate this thank you. I may need my test done again, as it was in the afternoon and I had taken my Levo and eaten lol.

[SlowDragon Administrator in reply to Kathy6]

Have you redone thyroid testing. Got vitamins tested

ALWAYS Test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

What brand levothyroxine are you currently taking